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Heart Disease Is Leading Cause Of Death In Men, Women In Texas

What are the risk factors for heart disease?

Heart disease is the leading cause of death for men and women in Texas. FOX 7's Rebecca Thomas speaks with a local cardiologist about risk factors for heart disease in this HealthBeat.

AUSTIN, Texas - February is American Heart Month in the U.S.

Heart disease is the leading cause of death for both men and women in Texas. Cases of heart disease in adults increased by 23% between 2021 and 2022. 

Dr. Vivek Goswami, a cardiologist with Heart Hospital of Austin and Austin Heart, joined FOX 7 Austin's Rebecca Thomas to discuss.

Austin Family: Heart disease in women

This month, Austin Family magazine is highlighting Heart Health Month. Heart disease is currently the leading cause of death among women in the United States, and heart disease accounts for 20 percent of female deaths, the CDC says. Alison Bogle joins us with more.

Rebecca Thomas: Dr. Goswami, what are some of the major risk factors for heart disease?

Dr. Vivek Goswami: Yeah, so when we talk about conventional heart disease, things like high blood pressure, high cholesterol, a family history of heart disease, diabetes, smoking, poor diet, poor exercise habits, and really age. And just being human more than anything are conventional risk factors of heart disease. 

Rebecca Thomas: Let's talk about screening and how important that is in detecting this early on.

Dr. Vivek Goswami: Yeah, sure. So, I think conventionally we've had a very reactive mindset when it comes to heart disease. We wait for people to have heart attacks. And then, if we're able, we place stents and perform bypass surgery and various other procedures. You know, for most people, 60% of the time, the first symptom of heart disease is a bad one. So, six out of ten times someone's sitting at home eating dinner with their family, feeling fine. And the next morning, sudden cardiac death and acute myocardial infarction. So if we don't make it to the hospital in time to utilize all of these great technological advances, we might as well live in 200 years ago. So, with that in mind, it's imperative that we get ahead of this. And screening is of the utmost importance. The day before someone has a fatal heart attack, they feel fine. So we really, really have to get ahead of it. And when people are feeling well, that's when we should be screening in advance to see where we stand. We should be keeping people healthy, not wait until they get sick and then try to retroactively try to fix us.

Rebecca Thomas: And much of the screening is so simple, you know, checking cholesterol, your blood pressure.

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Dr. Vivek Goswami: Correct, it is. And I think many people that go to their doctor on an annual basis will get things like their cholesterol and blood pressure checked in labs and blood sugars. You know, oftentimes, although these conventional risk factors can increase the risk of heart disease, there's not necessarily a 1 to 1 correlate. So it's possible for people to have high blood pressure but not have heart disease. And conversely, which is oftentimes, you know, much more scary. There are people who have normal cholesterol, normal blood pressure, they don't have a family history, and they can still have heart disease. It's analogous to say some people can speed while they're driving. The risk of getting in a car accident is higher, but it's not necessarily a 1 to 1 correlate. And conversely, some people who are driving the speed limit and are very safe drivers, could still get into car accidents. So the key is to screen for the disease, not just the risk of disease. There's no better marker of risk of heart disease than direct visualization. So I often recommend a screening calcium score to look for plaque in the heart arteries, screening for vascular screens. So look for early signs of plaque in the carotid. Subdermal I think these can tell a very important story. Not just in a lab test, but in the person sitting in front of us. And it's a way to personalize our risk stratification methods.

Rebecca Thomas: Final question. Let's talk about heart attacks and symptoms of heart attacks because they are different or can be different in men and women.

Dr. Vivek Goswami: They certainly can. So I think when we talk about conventional symptoms of heart disease, it's often referred to as chest discomfort, often described as a heaviness or pressure right in the center of the chest. Often, oftentimes, it can radiate to the left arm or jaw. It could be associated with shortness of breath, nausea, vomiting. Oftentimes, the symptoms get worse with exertion and are relieved with rest. These are very classic signs of a heart attack. Elephant sitting on the chest. And as you mentioned, oftentimes, women, unfortunately, can have very subtle or atypical, signs or symptoms of heart disease. So, sometimes women can just present with isolated back pain, throat discomfort, fatigue, just shortness of breath, just nausea. So the symptoms can be atypical or subtle. And we combine that with sometimes not having as much acknowledgment of risk, which can delay time for very critical treatment. And, that's thought to be one of the many theories why women do worse when they experience a heart attack when compared to men. 

Rebecca Thomas: All right. So if you feel off, see a doctor.

Dr. Vivek Goswami: That's right.

Rebecca Thomas: All right, Dr. Goswami, thank you so much for sharing your time and your expertise with us tonight.  

Heart Warrior Gives Back After Fighting Back Against CHD

8-year-old Bryson Hoover and his family donate blankets to Parkview Bryan Hospital years after a pair of life-saving surgeries.

BRYAN, Ohio — Commissioners in Williams County have officially declared the week of Feb. 7-14 Congenital Heart Defect (CHD) Awareness Week. The declaration is in no small part thanks to the work of heart families who live there.

"Every 1 out of 100 babies are born with it," heart mom Amanda Hoover said. "Our story first began eight years ago with my son being first diagnosed as a heart baby, spending 36 days in the NICU."

Hoover's son, Bryson, is now eight years old. He's been through a lot in less than a decade.

"He came six weeks early. A very easy natural labor. Then, once he got here, they couldn't get his oxygen sats up to where it needed to be so they pumped, hand pump oxygen into his face until the transfer team could come get him," Hoover said.

Bryson would spend 36 days in the neonatal intensive care unit (NICU). Hoover said doctors described her son as an enigma. It took teamwork to figure out what was wrong.

"The heart doctors, the lung doctors, neither one of them agreed it was their area," Hoover said. "Come to find out his diagnosis was in between but it is a congenital heart defect."

The Centers for Disease Control describes it as: 

A birth defect of the heart. In a baby with TAPVR, oxygen-rich blood does not return from the lungs to the left atrium. Instead, the oxygen-rich blood returns to the right side of the heart. Here, oxygen-rich blood mixes with oxygen-poor blood. This causes the baby to get less oxygen than is needed to the body. To survive with this defect, babies with TAPVR usually have a hole between the right atrium and the left atrium (an atrial septal defect) that allows the mixed blood to get to the left side of the heart and pumped out to the rest of the body. Some children can have other heart defects along with TAPVR, aside from the atrial septal defect.

Bryson would need life-saving surgery. After hours of waiting, Hoover said the surgeon came to speak with her.

"He came out from the door, shook his head and said 'We're not done yet,'" Hoover said.

Hoover said the surgeon explained Bryson would need a full repair. Once again, she was left to wait as doctors worked to save her son.

"You take away the worry for those children," Hoover said. "He didn't have anything to worry about, but we did. He just had to get better."

Both surgeries were a success. Bryson's condition was fully repaired.

Since then, the Hoover family has been giving back. They deliver blankets to Parkview Bryan Hospital in hopes of raising awareness and making sure newborns there are tested for CHD.

"The more awareness that brings about, maybe more people will listen," Hoover said. "More funding will come, more advancement, and eventually, hopefully, not an 18-year-old will just find out about their heart issue."

The Hoovers meet with heart families each year after the Williams County proclamation. For 2024, they gathered for a group photo at Spangler Candy World in Bryan.

Heart Disease And Pacemakers

A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm. A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure, and, rarely, hypertrophic cardiomyopathy.

It is implanted just under the skin of the chest during minor surgery. The healthy heart has its own pacemaker that regulates the rate at which the heart beats.

The heart has its own pacemaker that regulates the rate at which it beats. But some hearts don't beat regularly, a problem called arrhythmia. Often, a pacemaker device can correct it.

The pacemaker has two parts: the leads and a pulse generator. The pulse generator houses the battery and a tiny computer, and resides just under the skin of the chest. The leads are wires that are threaded through the veins into the heart and implanted into the heart muscle. They send impulses from the pulse generator to the heart muscle, as well as sense the heart's electrical activity.

Each impulse causes the heart to contract. The pacemaker may have one to three leads, depending on the type of pacemaker needed to treat your heart problem.

There are different types of pacemakers:

Single chamber pacemakers use one lead in the upper chambers (atria) or lower chambers (ventricles) of the heart.

Dual-chamber pacemakers use one lead in the atria and one lead in the right ventricle of your heart.

Biventricular pacemaker uses three leads: one placed in the right atrium, one placed in the right ventricle, and one placed near the left ventricle.

The doctor will program your minimum heart rate. When your heart rate drops below that set rate, your pacemaker generates (fires) an electrical impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heartbeat.

If your heart is having trouble maintaining its own rhythm, you may need one. Your doctor will do tests to find out for sure.

Pacemakers are usually used to treat the following:

Bradyarrhythmias. These are slow heart rhythms that may arise from disease in the heart's electrical conduction system (such as the SA node, AV node, or HIS-Purkinje system).

Heart failure. This device is called cardiac resynchronization therapy (CRT) or biventricular pacing.

If you need a pacemaker, your doctor will decide what type you need based on your heart condition.

Ask your doctor what medications you are allowed to take before getting a pacemaker implanted. Your doctor may ask you to stop taking certain drugs one to five days before the procedure. If you have diabetes, ask your doctor how you should adjust your diabetes medications.

Do not eat or drink anything after midnight the evening before the procedure. If you must take medications, take them only with a small sip of water.

When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

Pacemakers are implanted two ways:

Endocardial approach. This is the most common technique used.

This procedure is done in a pacemaker or electrophysiology lab.

A local anesthetic (pain-relieving medication) is given to numb the area. A cut is made in the chest where the leads and pacemaker are inserted.

The lead(s) is inserted through the incision and into a vein, then guided to the heart with the aid of a fluoroscopy machine.

The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.

Epicardial approach. This is more commonly used in children.

This procedure is done by a surgeon in a surgical suite. General anesthesia is given to put you to sleep.

The surgeon attaches the lead tip to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the abdomen.

Although recovery with the epicardial approach is longer than that of the other approach, minimally invasive techniques have enabled shorter hospital stays and quicker recovery times.

The doctor will determine which pacemaker implant method is best for you.

The endocardial pacemaker takes about 1-2 hours to implant.

What happens during pacemaker implantation?

You'll lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand. This is so you may receive medications and fluids during the procedure. You will be given medication through your IV to relax you and make you drowsy, but it will not put you to sleep.

The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure, and other measurements during the pacemaker implant.

The left or right side of your chest will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

How are pacemakers implanted?

The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then, it will become numb. Once this occurs, a cut will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.

After the pocket is made, the doctor will insert the leads into a vein and guide them into position using a fluoroscopy machine.

After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. You should report any pain right away.

After the leads are tested, the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer."

You will be admitted to the hospital overnight for the pacemaker implantation. The nurses will monitor your heart rate and rhythm. The morning after your implant, you will have a chest X-ray to ensure the leads and pacemaker are in the proper position.

You will be shown how to care for your wound. Keep your wound clean and dry. After 5 days, you may take a shower. Look at your wound every day to make sure it is healing. Your pacemaker settings will be checked before you leave the hospital.

You will receive a temporary ID card that tells you:

The type of pacemaker and leads you have

The date of the pacemaker implant

The name of the doctor who implanted the pacemaker

Within 3 months, you will receive a permanent card from the pacemaker company. CARRY THIS CARD WITH YOU AT ALL TIMES in case you need medical attention at another hospital.

Restrictions after pacemaker surgery

Do not lift objects that weigh more than 10 pounds.

Do not hold your arms above shoulder level for 3 weeks.

Avoid activities that require pushing or pulling heavy objects, such as shoveling the snow or mowing the lawn.

Stop any activity before you become overtired.

For 6 weeks after the procedure, avoid golfing, tennis, and swimming.

Try to walk as much as possible for exercise.

Ask your doctor when you can resume more strenuous activities.

Your doctor will tell you when you can go back to work, usually within a week after you go home. If you can, ease back to your regular work schedule.

How often will I need to see my doctor for my pacemaker?

A complete pacemaker check should be done 6 weeks after your pacemaker is implanted. Adjustments will be made that will prolong the life of your pacemaker. Then your pacemaker should be checked every 3 months on the telephone to tell how well its battery is working. Your nurse will explain how to check your pacemaker using the telephone transmitter. Once or twice a year, you will need a more complete exam at a hospital or doctor's office.

If you have a biventricular pacemaker, you may need to visit the doctor's office or hospital every 6 months to make sure your device is working properly and the settings do not need to be adjusted.

Talk with your doctor about the possible benefits and risks of pacemaker surgery.

Pacemaker surgery is generally safe, but problems do happen. Call your doctor if you notice:

Increased swelling, bleeding, bruising, or infection near the site

Blood vessel or nerve damage

A collapsed lung

Reaction to any medicine used during the surgery

Should I avoid certain electrical devices if I have a pacemaker?

Electric blankets, heating pads, and microwave ovens can be used and will not interfere with the function of your pacemaker.

A cellphone should be used on the side opposite of where the pacemaker was implanted.

Cellphones should not be placed directly against the chest or on the same side as your pacemaker.

You will need to avoid strong electric or magnetic fields, such as: some industrial equipment; ham radios; high intensity radio waves (found near large electrical generators, power plants, or radio frequency transmission towers); and arc resistance welders.

Do not have any tests that require magnetic resonance imaging (MRI) unless you have been told that you have an MRI-compatible pacemaker.

When going through airport security, show your pacemaker card without going through the screening machine because the pacemaker will set off the security alarms.

Your doctor or nurse can provide more information about what types of equipment may interfere with your pacemaker.

If you have concerns about your job or activities, ask your doctor.

How long will my pacemaker last?

A pacemaker usually lasts 7 to 10 years, depending on how often it is used. When the battery becomes low, your pulse generator will need to be replaced.

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